NGS Telehealth Billing FAQs for COVID-19

NGS Telehealth Billing FAQs for COVID-19 Changes What has changed in Medicare coverage for telehealth services? Answer: There are 85 new codes added to the list of services that can be delivered via telehealth. List of Telehealth [...]

Accessing the NGS FISS DDE System

Accessing the NGS FISS DDE System As we previously communicated via the May 2023 Dark Days for CMS Data Migration - Rescheduled May 2023 Dark Days for Data Center Migration, the Medicare Part A CMS Data Center Migration took place this past [...]

Attention Home Health and Hospice Providers Using NGSConnex to Submit Level One Appeals Redetermination Requests

Attention Home Health and Hospice Providers Using NGSConnex to Submit Level One Appeals Redetermination Requests National Government Services strongly recommends that all providers, including home health and hospice agencies, utilize NGSConnex [...]

Billing and Coding Article Updates for May and June 2023

Billing and Coding Article Updates for May and June 2023 Self-Administered Drug Exclusion List: Medical Policy Article A53021 (JK) and A53022 (J6) The article has been updated to add: Adalimumab-aacf (Idacio®), Adalimumab-afzb (Abrilada™), [...]

MLN Connects® Newsletter: May 25, 2023

MLN Connects® Newsletter:  May 25, 2023 News DMEPOS Competitive Bidding Program: Temporary Gap Period Starts January 1 CMS Roundup (May 19, 2023) Medicare Providers: Deadlines for Joining an Accountable Care Organization [...]

Billing and Reimbursement for Penile Pressure Cuff

Billing and Reimbursement for Penile Pressure Cuff Effective 6/1/2023, when billing for penile pressure cuff used for the provision of a voiding pressure study, please submit using CPT code 55899 (unlisted procedure, male genital [...]

Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information

Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks Field (FL 80, or electronic [...]

Claims for Drugs Without a Product-Specific Code Assigned

Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]

How to Avoid Duplicate Claim Denials

July 2023 Release "Dark Days" for the Common Working File Hosts

July 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming July 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 6/29/2023 and Dark Days starting Friday, 6/30/2023 through Sunday, 7/2/2023 to [...]

Best Practices for a Successful Targeted Probe and Educate Review

End of Public Health Emergency

End of the Public Health Emergency Frequently Asked Questions

End of the Public Health Emergency Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to questions about the End of the Public Health Emergency to ensure you have [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to common questions about Drugs and Biologicals to ensure you have the information you need [...]

Government Efforts to Combat Cancer Deaths Related to Tobacco

Government Efforts to Combat Cancer Deaths Related to Tobacco Tobacco use is the leading preventable cause of cancer and cancer deaths. Lung cancer is what normally is thought of when talking about tobacco and cancer, but there are other [...]

Ways to Submit Requests

Ways to Submit Requests Suppliers have multiple options to submit PA requests to NGS. NGSConnex (preferred) Electronic submission of medical documentation (esMD) Fax JK: 315-442-4178 J6: 717-565-3840 U.S. Mail National [...]

Rhinoplasty and Related Services

General Documentation Requirements for Rhinoplasty and Related Services Checklist of prior authorization request (PAR) information to include: Medical documentation, with evaluation and management, supporting medical necessity of the [...]

MLN Connects® Newsletter: June 15, 2023

MLN Connects® Newsletter: June 15, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Announces Multi-State Initiative to Strengthen Primary Care [...]

Reactivating Reason Code 31755

Reactivating Reason Code 31755 As of 1/3/2023, reason code 31755 was reactivated per CMS instructions. This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim. [...]

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device VAD supplies and accessories are billed using HCPCS codes Q0507, Q0508 and Q0509 as applicable. When billing for VAD supplies, [...]

Claims Department Requires Additional Information for Processing Certain Services

Claims Department Requires Additional Information for Processing Certain Services Are you having difficulty with what must be provided when we ask for additional information to process your claim? If so, the following articles should assist in [...]

Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services

General Documentation Requirements for Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services Checklist of prior authorization request (PAR) information to include: Stable weight loss [...]

MLN Connects® Newsletter: June 22, 2023

MLN Connects® Newsletter: June 22, 2023 News CMS Roundup (June 16, 2023) Lower Endoscopy: Comparative Billing Report in June Medicare Physician Fee Schedule Database: July Update Behavioral Health Integration Services: Get Information [...]

Prior Authorization Request for Outpatient Services: Facet Joint Interventions

Dental Services 2023

Dental Services 2023 The CMS clarified what Medicare payments may be made for medically necessary dental services that are an integral part of a covered primary medical procedure. We’ve posted this new information in the Dental Services [...]

End of the Public Health Emergency

End of the Public Health Emergency We’ve received many questions related to end of the public health emergency and changes to waivers that CMS put in place during the COVID-19 PHE. To assist our providers, we’ve developed the CMS Waivers and [...]

COVID-19 Vaccine Administration Returning to Providers - Reason Code 32287

Claims for COVID-19 vaccine administration performed on the same DOS as another vaccine administration (e.g., PPV, flu or tetanus) are incorrectly being returned to providers with RC 32287.

Part A Anesthesia Claim Returning to Providers in Error

CMS has instructed all MACs to hold all Part A 13X and 85X TOBs for anesthesia services with DOS on or after 1/1/2022 until CMS fully implements a replacement file for these claims.

Temporary Holding for Some Part B Claims

The CMS billing instructions for G0378 indicate a single line of coding with a NOS of at least eight, with all UOS on a single line and the DOS being the date of the original observation order. Claim editing changes implemented in July, 2021 [...]

Billing and Coding Article Updates for July 2023

Billing and Coding Article Updates for July 2023 Billing and Coding: Bevacizumab and Biosimilars (A52370) Based on Compendia review, ICD-10 codes Z85.09 and Z85.42 have been added to the Group 1 code list effective for dates of service on or [...]

Telehealth Home Health Billing

Telehealth Home Health Billing  As a reminder to all home health agencies, telehealth billing becomes mandatory on home health claims for periods of care that start on or after 7/1/2023. There is an article detailing how to report [...]

New and Improved EDI Enrollment Process Coming Soon

New and Improved EDI Enrollment Process Coming Soon We are improving our online EDI Enrollment process based on provider feedback. The new process will include ‘real time’ verification of data entered into many of the fields. This ‘real time’ [...]

MLN Connects® Newsletter: June 29, 2023

MLN Connects® Newsletter: June 29, 2023 News CY 2024 ESRD Prospective Payment System Proposed Rule Transforming Medicare Coverage: A New Medicare Coverage Pathway for Emerging Technologies and Revamped Evidence Development Framework New [...]

Conflict of Interest Disclosure

Conflict of Interest Disclosure Statement Form

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Posted 7/5/2023

MLN Connects® Newsletter: July 6, 2023

MLN Connects® Newsletter: July 6, 2023 News CY 2024 Home Health Prospective Payment System Proposed Rule HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices CMS Roundup (June 30, 2023) [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Jurisdiction 6 and Jurisdiction K Bobbi Jo Luciano Office: South Portland, ME 207-253-3382 Email: [...]

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023 News Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following [...]

Overcoming Barriers to Tobacco Counseling 

Overcoming Barriers to Tobacco Counseling Healthcare providers face several challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ performance [...]

Submitting Necessary/Appropriate Documentation

Submitting Necessary/Appropriate Documentation National Government Services has noticed an increase in the submission of improper documentation. We’ve added two new sections to our Submit Medical Record Documentation Electronically job aid to [...]